Primary hyperparathyroidism and parathyroid carcinoma

Abstract

We present two cases of parathyroid carcinoma, confirmed histopathologically, and a third case of primary hyperparathyroidism (PHPT), which analytically and imagiologically could represent a third carcinoma, but without pathological confirma­ tion.

The three patients had the common and typical clinicai manifestations of hyperparathyroidism. They ali showed laboratory alterations: a persistently raised serum calcium, increased leveis of parathyroid hormone and very similar imaging findings.

The first two cases of this communication, document ways in which parathyroid carcinoma can present itself: 1) An emergency, if not dramatic, presentation in the first case, which was very difficult to treat (AJC, 64 years old female); and 2) Bone changes in the second case (DRS, 18 year old male), in which there was evidence of parathyroid gland capsule invasion which was surgically excised). Both patients had pathological bone fractures with pseudo-tumoral aspects and were transferred from the Orthopaedic Department - Bone Tumours Section- to our department.

The third case involved a patient (MCPM, aged 67) who died the day before surgery, who had nodules on the ultrasound, probably of the parathyroid gland, but without pathological confirmation.

The three patients had clinicai manifestations of hypercalcaemia, as well as very high serum calcium values (maximum values were 15.1, 18.6 and 22.4 mgldl) and PTH values more than ten times the upper limit of normal (1956 pglml, 805 pglml e 15 nglml, with upper limits of normality of 72 pglml, 55 pglml e 1.4 nglml, respectively).

We highlight the importance of considering parathyroid carcinoma in the aetiology of hyper­ parathyroidism, since it has a substantial morbidity and mortality, and the prognosis is dependent on timely diagnosis and surgical intervention.